Pre-Cel111ication Orientation Workshop

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1 .. Getting a Child Ca.re Center Group Home Started Pre-Cel111ication Orientation Workshop I ' I This tr~ining was developed through cooperative efforts of the Pennsylvania Department of Public Welfare, Office of Child Development and Early Learning, Bureau of Certification Services and the Pennsylvania. State University, Better Kid.Care ~rogram.

2 Gettin Started in Child Care Child Care Centers and Grou Homes ( Getting a Child Care Center or Group Home Started Pre-Certification Orientation Workshop Contents Regional Certification Offices...,... 4 Regional Map... ;... 5 Regulations... 6 Child Care Regulations on the Internet... 7 Negative Sanctions and Drug Related Offenses... 8 Steps Before You Open...,..:...,... 9 Steps to Take Before You Open a Child Care Center or Group Child Care Home : 10 Application for Certification... :... ; Make Sure Your Application Packa.ge Is Complete... :....' Instructions for Completion of an Application for a Certificate of Compliance... : Application for Certificate of Compliance..., Certificate of Occupancy ( How to Get a Certificate of Occupancy for a Child Care Center or Group Child Care Home (not located in a private home) How to Get a Certificate of Occupancy for a. Group Child Care Home (located in a private home) Requirements for R 3 Certificate of Occupancy for a Group Child Care.Home (located in a private home) Certificate of Occupancy Requirements City of Philadelphia Requirements for Operating a Commercial Day Care: Chlld Care Center and Group Child Care Home Not in a Residence... : City of Philadelphia Licenses & Inspections Fire Safety Requirements for Commercial Day Care City of Philadelphia Requirements for Operating a Group Child Care Home Located in a Residence City of Philadelphia Licenses & Inspections. Fire Safety Requirements for Group Child Care Home Located.in a Residence Backg.round Checks Pennsylvania Child Abuse Mistory Clearance CY Instructions to Complete: Pennsylvania Child Abuse History Clearanq:! Form Pennsylvania State Police Request for Criminal Record Check,..., 38 Instructions for FBI Criminal History Clearance... 39

3 Gettin Started in Child Care Child Care Centers and Grou Homes Fictitious Names PA Department of State- Fictitious Name Application :e PA Department qf State- Instructions for Completing Fictitious Name Application Profit/Not-for-Profit... : For-Profit and Not-For-Profit Children's Programs Similarities and Differences Bureau o{equal Opportunity...: Bureau of Equal Opportunity Regional Offices Civil Rights Compliance Questionnaire.:._...: Sample #1- Civil Rights Nondiscrimination Policy Statement Sample #2 -Civil Rights Nondiscrimination in Services Statement Tax Information....'... :..._....,. 56 Employer Identification Number (EIN) How to Apply for an EJN... : Application for Employer Identification Number (IRS Form SS-4) Do I Need an EIN? (IRS Form SS-4) Pennsylvania Tax Exemption Certificate (REV-1220)..., Tax Information Child Care center and_ Group Child Care Home... ~ First Inspection Requirements...: First Inspection Requirements for New Child Care Centers...: First Inspection ~equirement? for New Group Child Care Homes First Inspection Requirements for New School-Age Child Care Centers General ~iability Insurance Resources...,...; Re?o~rces for. Opening a Child Care Center or Group Child Car~ t1ome..._... ~ Useful Web links... :... ~ Your Guide to New Crib Standards (US CPSC) A Safer Generation of Cribs (US CPSC) The New Crib Standard: Questions and AnsWers...;...; Child Care Agreement Form EmergenCy Contact and Parental Consent Form Exercises:....'...:...; Calculating Child Care Space...A-1 Regulations search for Child Care Centers...."... ~... B-1 _Regulations SearCh for Group Child -Care Homes_... ;... C-1

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5 '. '.... Office ofchild Developmentand Learning Re~iori~ Wester"n.RBgiOn North-Central" RegiOn -b~'::. 6ffice Orchnd-; Of.fiCe: of Child DevelOpment Office of Chlld.DeveiOpment an~ early Learning D8vei0Pil1Emt:and Early Lelirning arid Early Learning SE Region Bureau of. '1i Stanwlx Street,. Room- 240 HarriSburg Scranton Certificatfcin- Pittsburgh~!?A DGS Annex, Hllrcrest # lackawanna Ave-nue 801 MarRCL Street Telephone: (412) P.o, Box 2675 scranton State Office Bldg. Su~e Toll Free: (800) 222c2-149 Philadelphia, PA1910I-3126 Harrisburg,.PA Scranton, PA Telephone: (215) 560-2&41 Fax: (412) Telephone: (717) 77N078 Telephone: (&70) Toll Free: (800) Toll Free: (800) Toll Free: (800) Fax: [215)560:5139 COUNTIES Fax: (717) Fax: (570) 963,3006 AliSgheny. COUNTIES Armstrong COUNTIES Berks >Beaver Ad_ams BradfOrd BUcks Bedford Centre Carbo.rl Chester Blair Clinton La~kaWanna Delaware Butler ColUmbia Lehigh Montgomery Cambria C~fn~erland Lu.Zenle Philadelphia.cameron oauphln Molifbe Clarlon Juniata Northampton Ciearfie!d Lancaster Pike. Crawford Lebanon Schuylkill Elk.[.yearning Sullivan 'Erie Miffirn Susquehanna Fayette Forest Montour Tioga.Franklin Morthumberland Wayne Fulton Perry Wyoming Greene Snyder HuntingdOn Union lnd18na York Jefferson lawrence =- :.--_lnterest9"d in operating a child care faciiit-y? = _:_ :-=_ -McKean Plea~.contact your ~glonal Office of Child DeVelopment and Early Learning for more Mercer!nfoi-mat16n. Potter Somerset -Venango Have a question-or complaint about a. child care facility? Warren Please contact yo.ur regional' Office of Child Development and Early Leam!nQ. Washlhgton ContaCt Information for each.regional office-is listed above.. l;he cot.intles InCluded In each.reg!on. Westmoreland the:fe9ional office address and-the telephone nufnbers are lfsted below each region '-~ ~ co_ 206 \1110 5

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7 Gettin Started in Child Care Child Care Centers and Grou Homes Child Care Regulations on the Internet.The Department of Public Welfare (DPW) regulations for operating child care facilities are on the Internet. These are the most up-to-date versions of the regulations. Regulation for Child Care Centers (55 Pa. tode, Chapter 3270) A child care center offers care for seven or more children who are not related to the operator. A child care center must have a Certificate of Compliance (license) from DPW in order to operate. This regulation can be found on the internet <lt: Regulation for Group Child Care Homes (55 Pa. Code, Chapter 3280) A group child care home offers care for seven to twelve children who are not related to the operator. A group child care home must have a Certificate of Compliance (license) from DPW in order to operate. This regulation can be found on the internet at: Regulation for Family Child Care Homes (55 Pa. Code, Chapter 3290) A family child care home offers care to four, five or six children-who are not related to the operator. A family child care home must be located in a h9me and must have a Certificate of Registration from DPW in order to operate. This regulation can be found on the internet at: Regulation for Licensure or Approval of F;'lcilities and Agencies (55 Pa. Code, Chapter 20). This regulation provides rules for applying for a Certificate of Compliance (license), frequency and content of DPW inspections, preparing and issuing a Certificate of Compliance, conditions under which a Certificate ofcompliance may be denied, not renewed, or revoked and the DPW licensure or approval decisions that may be appealed. This regulation applies only to child care centers and group child care homes. This regulation can be found on the internet at: pacode.com/secure/data/055/chapter20/chap20toc.html 7

8 Negative Sanctions and Drug Related Offenses The regulations relating to child care facilities address several reasons that a certificate of compliance may be taken away. It is important that you are aware of those reasons. Your actions and the actions of your staff impact continued operation of your child care facility. Below are regulations that detail conditions that may result in the loss of a certificate ofcompliance.. The Department of Public Welfare has zero tolerance relating to the sale, usage or deliver'{ of illegal drugs at a child care facility by any legal entity, operator or faculty employee. Any such action will resuli in removal of your certificate of compliance. Additionally, no individual who has been convicted of or who is awaiting trial on criminal charges described in the regulation may be present in the facility (see Pa. Code (c) and (c), relating to suitability of persons in the facility). 55 Pa. Code Conditions for denial. nonrenewal or revocation. (a) The Department may deny, refuse to renew or revoke a certificate of compliance for any of the following: (1) Failure to comply with this chapter (55 Pa. Cod'e Chapter 20). (2) Noncompliance with the Department's program licensure or approval regulations (55 Pa. Code Chapter 3270 or 3280, as applicable). (3) Failure to submit an acceptable plan to correct noncompliance items. (4) Failure to comply with the acceptable plan to. correct noncompliance items. (5) Mistreatment or abuse of clients being cared for in the facility or receiving service from the agency. (6) Gross incompetence, negligence or misconduct in operating the facility or agency. (7) Fraud or deceit In obtaining or attempting to obtain a certificate of compliance. (8) lending, borrowing or using the certificate of compliance of another facility or agency, or knowingly aiding or abetting the improper granting of a certificate of compliance. (b) The Department will review and may deny, refuse to renew or revoke a certificate of compliance if a legal.entity, owner, op~rator or staff person: (1) Has been convicteq of a felony. (2) Has been convicted of a crime involving child abuse, child neglect, moral turpitude or physical violence. (3) Has serious mental illness which might create a risk to the clients, which shall be determined and documented by a licensed physician or a licensed psychologist. (4) Has evidenced drug or alcohol addiction within the past year, which shall be determined and documented by a licensed physician.. (5) Has been named as a perpetrator in an indicated offounded report of child abuse in accordance with the Child Protective Services Law (11 P. s ). 55 Pa. Code Suitability of persons in the facility. (a) The operator shall comply with the Child Protective Services Law (CPSL) and with 55 Pa. Code Chapter 3490 (relating to protective services). (b) Questions relating to the requirements of the CPSL shall be directed to the appropriate regional child day care office. (c) The operator may not allow an individual to enter the facility if the operator knows that the individual has been convicted or is awaiting trial on charges involving a crime of child abuse, child neglect, physical violence or moral corruptness, 55 P a. Code Suitability of persons in the facility. (a) The operator shall comply with the Child Protective Services Law (CPSL) and with 55 Pa. Code Chapter 3490 (relating to protective services). (b) Questions relating (o the requirements of the CPSL shall be directed to the appropriate regional child day care office. (c) The operator may not allow an individual to enter the facility if the operator knows that the individual has been convicted or is awaiting trial on charges involving a crime of child abuse, child neglect, physical violence or moral corruptness. 8

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10 Gettin(! Started in Child Care Child Care Centers and Group Homes Steps to Take Before You Open a Child Care Center or Group Child Care Home Have you chosen a location? Check with local zoning regulations to make sure child care is an allowed use. You may have to choose another site or try to geta Zoningvariance. Local realtors Community leaders Date completed: Notes: Is this site a safe place for children and families? Check proposed site for hazards to children, families, and staff. Notes: Date completed: Is there enough space at this site to meet,requir_ements for child ca_re and active play space? Compare the proposed site with regulations. Is there enough indoor play space?.is there active play space indoors or outdoors? Department of Public welfare regulations for Child Day Care Centers or Group Child Care Homes Date completed: Does this site need renovations to meet regulation requirements? Notes: look at the regulations"for ilghting, wate~, heat, ventilation, stairways> paint, ~ urface requiremen"ts; etc. Note." renovations that need to be. made. ' Notes: See regulations for measurement and use of in~oor child care SPC!Ce and measurement and use of play space. Department of Public Welfare regulations for your facility Child DayCare Cente'rs or Group Child. Care Homes Date completed: *Items marked with an asterisk("') are required parts of the application package for child care centers and group homes. Other items may be necessary, depending on how the child care facility will be organized and operated. 10 ~T

11 ~ Gettin Child Care Centers and Grouo Homes Who conducts inspections for the Uniform Construction Code in your area? Request a site visit from a local building inspector before you buy or re~t a buildi~g: for a child care site: This will give you an idea of work that will need to be done to meet the Uniform Construction Code. Contact local municipal office to determine ifthat office conducts inspections orif you will need to call the Pennsylvania Department of Labor and Industry for the inspection. Notes: See Certificate of Occupancy section, in this handout mantiai for more information about determining if a local municipality conducts fire safety inspections and what to ask for. Date completed: Who will?wn your business and how will it be run? I Paperwork needs to be completed depending on how your business will be owned and run. Loc;al business attorney Lotai accountant' Department of State Business ~ Will your business be part of a corporation? If your business will be part9f _a C9fP9f~tio,n, C<?ntact corporate office or file for Articles of Incorporation with the Pennsylvania Department of State Corporation Bureau. Local business attorney "A Beginner's Guide to Starting a Small Business in Pennsylvania"- on.the Web at business.state.ba.us "A Guide to Business Registration in PA"- on the Web at Date: Corporate office. contacted Date: File paperwork.for Articles of Incorporation 0 Doesn't apply *Items marked with an asterisk("') are required parts of the application package for child care centers and group homes..other items may be necessary, depending on how the child care facility will be organized cind operated. 11

12 ------,- Will your business be part of Limited Partnership (lp)? If your business will be part of a limited Partnership, you'll need to file for a Certificate of limited Partnership with the Pennsylvania Department of State Corporation Bureau. Local business attorney "A Guide to Business Registration in PA"- ofl the Web at Date: File paperwork for Certificate of limited Partnership Doesn't apply Will your business be part of limited liability Partnership (llp)? If your business will be part of a limited liability Partnership, you'll need to file for a Statement of Registration for a Domestic limited liability Partnership with the Pennsylvania Department of State Corporation Bureau. local business attorney "A Guide to Business Registration in PA"- on the Web at Date: File paperwork for Statement of Registration for a Domestic limited liability Partnership D Doesn't apply Will your business be part of limited liability Company (llc)? If your business will be part of a limited liability Company, you'll need to file a Certificate of Organization for a Domestic Limited Liability Company with the Pennsylvania Department of State Corporation Bureau. Local business attorney ' 1 fj:. Guid~ to Business Registration in PA" - ~:m the Web at Date: File paperwork for Certificate Of Organization for a Domestic limited liability Company Doesn't apply *Items marked with an' asterisk(*) are required parts of the application package for child care centers and group homes... Other items may be necessary, depending on how the child care facility will be organized and operated. 12

13 Non-profit operations need certificate of tax-exempt status (REV 1220) to include with application. Will your child care be run as a profit or non-profit business?_ PA Department of Revenue WVN~.revenue.state.pa.us See Profit/Non-Profit section in the handout manual for a comparison. A copy of REV 1220 and instructions to complete the forin are in the Tax Information section of the handout manual. Date: Form completed and sent for tax-exempt staws I Date: I Certificate of Tax Exempt Status received D Doesn't apply Will your business have a fictitious name? If your business will use a fictitious name, file Application for Registration of Fictitious Name with PA Department of State Corporation Bureau. PA Department of State.Corporation Bureau See Fictitious Name-section in handout manual for application and instructions to complete it. Date: Form filed to register fictitious name Date: Rictitious name approval received D Doesn't apply *Items marked with an asterisk(*) are required parts of the application package for child care centers and group homes. Other items may be necessary, depending on how the child care facility will be orgar:tized cind operated. 13

14 Getting Started in Child Care Child Care Centers and Grouo Homes Do you need a Federal Employer Identification Number {Federal EIN)? If you need an EIN, complete and file SS-4- Application for Employer Identification Number. www:irs.gov "Do you need an EIN?"- and EIN application form (SS-4) in the Tax Information section of this handout manual. Instructions for completing form are included. Apply by Date: EIN form (SS-4) filed with IRS Date: EIN number received 0 Doesn't apply mail, online, fax, or phone. For more information: "A Beginner's Guide to Starting a Smail BUsiness ih =, Pennsylvahicl"...:.. on the Web at *Do you have a current (l~ss than one year old) clearance indicating you do not have a II history of child abuse? Complete the Pennsylvania Child Abuse History Clearance Form. Submit completed form, with processing fee, to: Department of Public Welfare Childline and Abuse Registry P.O. Box 8170 Harrisburg, PA Department of Public Welfare Childlirie and Abuse Registry, See Background Checks section. in this handout manual for form. Instructions for completihgthe form are included. Download the. form from the web at: cmprd/grou 0 s/webcontent/do cuments/form/s pdf Date: Child Abuse History Form completed and sent Date: *Response form received *Items marked with an asterisk(*) are required parts of the application package for child care centers and group homes. Other items may b~ necessary, depending on how the child care facility will be organized, ancf_operated. 14

15 ~~'Do you have a current {less than one year old) Pennsylvania criminal record clearance? Complete Request for Criminal Record Check form. Submit completed form, with processing fee, to: Pennsylvania State.Police Central Repository Elmerton Avenue Harrisburg, PA Pennsylvania State Poiice Date: See Background Checks Request for Criminal section in this handout manual Record for form or complete and. Check form completed submit form online at: and sent cmprd/groups/webcontent/do I Date: cuments/form/s pdf *Response form received!i< Do you have a current {less than one year old) FBI Criminal History Clearance? Contact Cogent at https:/ /www.pa.cogentid.com/index_dpw.htm or call See Background Checks I Date: se.ction in this handout manual Registered for for instructions to get an FBI fingerprinting Criminal History Clearance. Date: Completed fingerprinting Date: *Re.SP6Dse received from Child line *items marked with an asterisk(*) are required parts ofthe application package for child care centers and group homes. Other items may be necessary, depending on how the child care facility will be organized and operated. 15

16 0 Getting Started in Child Care Child Care Centers and Group Homes bo you live outside of Pennsylvania?. If you don't have a current (less than one year old) FBI Criminal History Clearance, contact Cogent at https:(/www.pa.cogentid.com/index_dpw.htm or call or contact the fingerprinting system in your own state of residence to obtain a FBI Criminal History Clearance. Completed forms must be submitted to Child line for review at the following address: See Background Chec:ks section in this handout manual for instructions to get an FBI Criminal History Clearance for people who live outside of Pennsylvania. Date: Made arrangements for fingerprinting Date: Completed fingerprinting Department of Public Welfare Childline and Abuse Registry P.O. Box 8170 Harrisburg, PA Date: *Response received from Childline *Have you completed and filed the forms and policy statements to your Bureau of Equal Opportunity Regional Office? Complete Civil Rights Compliance Questionnaire Attachment 1, Nondiscrimination Policy Statement of Equal Employment Opportunity, and Nondiscrimination in Services Policy Statement. Submit to PA Department of Public Welfare, Bureau of Equal Opportunity regional office. PA Department of Public Welfare, Bureau of Equal Opportunity (BED). See Bureau of Equal Opportunity section in this handout manual for Contact infdrmation for BED RegionaiOffices, Civil Rights Compliance Questionnaire-.'and fdrms. Date: Civil Rights questionnaire and other Bureau Of Economic Opportunity forms and policy statements completed and sent. Date: "'Letter of verification received. ~. *Items marked with an asterisk("') are required parts of the app!ic<itiori package for child care centers and group homes. Other-items may be necessary, depending on how the child care facility will be organii:ed_~nd operated. 16

17 "'Do you have a Gertificate of Occupancy for the building Where your child care center or group home will be located? A building fire safety approval inspection needs to be completed and a Certificate of Occupancy obtained. Local municipality where the building is located or the Pennsylvania Department of Labor and Industry. See Certificate of Occupancy section in this handout manual Date: Called to schedule inspection Date: Scheduled inspection for more information on who to call and,hh'at to ask for when scheduling an Date: certificate of it1spection, Occupancy received Are you planning to participate in the child care subsidy and/or the Reference and Referral program? Complete form: Tax Information: Child Day Care Center and Group Day Care Home Attach a letter, form, tax form, of application from the IRS, with the Employer Identification Number (EIN) pre-printed on it. See Tax Information section in this handout manual for a copy of the Tax Information form. Date: Tax Information form completed 0 Doesn't apply *Items marked with an asterisk(*) are required parts of the application package for child care centers and group homes. other. items may be necessary, depe~ding on how the child care facility will be organized,and operated. 17

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19 Getting Started in Child Care Child Care Centers and Group Homes Make Sure Your Application Package is Complete Use this checklist to make sure your application package for a Certificate of Compliance is complete before mailing it. Incomplete application packages will be returned without processing. *Completed Application for Certificate of Compliance *A copy of the Certificate of Occupancy from your local municipality or Labor and Industry *Original Child Abuse History clearance form for the legal entity or legal entity representative and the responsible person, clearance must be less than 3 months old *Original Criminal Record Check from the Pennsylvania State Police for the legal entity or legal entity representative and the responsible person, clearance must be less than 3 months old *Original FBI Fingerprinting Criminal History clearance for the legal entity or legal entity representative and the responsible person, clearance must be less than 3 months old * For Group Homes operating in a residence: Original Child Abuse History clearance, Original Criminal Record Check and Original FBI Fingerprinting Criminal History clearance for everyone 18 years of age and older, clearance must be less than 3 months old *A copy of the verification from the Bureau of Equal Opportunity stating that you have completed and filed the Civil Rights Compliance Questionnaire *A copy of a signed certificate documenting that a representative of your legal entity attended orientation training Getting Started in Child Care * Certificate of completion of the mandated reporter training: Recognizing and Reporting Child Abuse: Mandated and Permissive Reporting in Pennsylvania A copy of the Articles of Incorporation if you incorporated your child care business A copy of the Certification of Limited Partnership if your child care business is part of a limited partnership A copy of the Registration for a Limited Liability Partnership (LLP) if your child care business is part of a limited liability partnership A copy of the Certification of Organization for a Limited Liability Company (LLC) if your child care business is part of a limited liability company A copy of the Certification of Tax-Exempt Status or 501(c)(3) if your child care is a non-profit business A copy of the fictitious name approval form if you plan to use a fictitious name for your child care Completed Tax Information: Child Care Center and Group Child Care Home form if your child care facility will participate in the child care subsidy and/or Resource and Referral programs proof of Federal Employer Identification (FEIN) from the IRS must be attached Make and keep a copy of all the material in our application package before mailing it *Items with an asterisk (*) are required in every application package Complete application packages should be mailed to the Regional Office of Child Development and Early Learning (OCDEL) that serves your county. Please refer to the map included in the information you received at your orientation session. North Central Region OCDEL Southeast Region OCDEL DGS Annex Hillcrest # Market Street P.O. Box 2675 Suite 5132 Harrisburg, Pennsylvania Philadelphia, Pennsylvania or North Central Region OCDEL Western Region OCDEL 100 Lackawanna Avenue 11 Stanwix Street Scranton State Office Building Suite 240 Scranton, Pennsylvania Pittsburgh, Pennsylvania Updated December 1, 2014

20 INSTRUCTIONS FOR COMPLETION OF AN APPLICATION FOR A CERTIF1CATE OF COMPLIANCE FORA CERTIFIED CHILD CARE CENTER OR. A GROUP CHILD CARE HOME APPLICATION PURPOSE: Ob!!!l New Facfllty: A new agency/facility Renew Kdstlng Facility: An agency/facility applying to renew their existing Certificate of Compliance. The name and address of the Agency/Facility and the name of the legal entity should be the same as it is on the existing Certification of Compliance, Change of Facllity!Legal Entity Information: An agency that bas had an update of previously submitted information such as an agency/facility name change, ~gency~facility address change or a change in the legal entity nafne. IDENTIFICATION: 1. LOCATION NAME, PHYSICAL ADDRESS, MAILING ADDRESS, ADDRESS, ' TELEPHONE NUMBER, CELL PRONE NUMBERi Iodicate name,. physical address, mailing address, addraas, telephone and ceu phone number of the physical location where lhe child care services are provided. Ifthe application is for a renewal of an existing certificate, the name and adrbess ofthe location should be the same as on the previous application. A post office box may not be entered in!be physlc:a] address informati~n. _ LEGAL ENTITY NAME, PHYSICAL ADDRESS, MAILING ADDRESS, ADDRESS, TELEPHONE NUMBER, CELL PRONE NUMBER: Indicate name~ physical address, mailing address, address, telephone and c_ell phone number of the legal entity. A post office box may not be entered in the physical address ihlormation. 3. RESPONSIBLE PERSON: Indicate the full1lallle aod title of the person who is responsible for the daily operation of the facility. 4. COUNTY AND MUNICIPALITYrrOWNSHIP/BOROUGH:. Iodicate the name ~f the county and municipality/towushiplborough in which the facility location where child care services are provided is located. 5. TYPE OF FACILITY: Iodicate the type of child care fucility you wish to operate: Clu1d Care Ceoter or Group Child Care Rome. 6. TAX IDENTIFIER: Iodicate the FEIN ofthe person, partnership, association, organization, corporation or governmental body responsible for ilie operation of the facility: 1. TYPE OF OPERATION: Profit: Qperating with the expectation ofproviding a financial benefit to someone or. something other than the facility itself. The focus upon the Ultimate aim of the enterprise, not the financial results of an_y particular period of operation. The focus is also upon_ the particular premises involved and not the legal entity which operates the facility. A non profit legal entity may be considered as operating a faoility for profit ifthe particular premises involved provides a finailcial benefit to the parent legal entity. Any legal entity not possessing a certificate of tax exempt status from the Internal Revenue Service will be considered operating for profit unless it provides satisfactory proof othenv:is.e. Non-Profit: Operating other than for profit Copy oftax exempt certificate sbould be submitted with the initial application. 8, TYPE OF OWNERSHIP: Identify the type of owners!)ip. 9. Please answer YES or NO a:nd explain any YES response on a separate sheet of paper. 10.Please answer YES or NO and explain any YES response on a separate sheet of paper. 11. Please answer YES or NO and explain any YES response on a separate sheet of paper. ATTACHMENTS: Attach =tcertificate of Ocenpancy, Articles ofincorporation, State Fictitious Name Approval, Tax Docnmentation, Bnreau of Equal Qpportuillty Compliance Letter DECLAJiATION: The Declaration mnst be.,;igoed by the legal entity. If the legal entity is a partnership, association, or organi2ation, the person authorized to sign such documents must sign. Where the legal entity is a COiporation, the sigusture must be of a corporate officet. Type or print the name and title of the pernon signing. 20.

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